By Cara Rosenbloom
When my period was a week late, it brought three questions to mind: Am I pregnant? (I'm 46 and have two kids. Another child is not part of the plan!) Am I perimenopausal? Or is it just stress from this pandemic?
Turns out, I'm not alone in having an unpredictable menstrual cycle during the coronavirus pandemic. After seeing some online reports about this trend, I spoke with several gynecologists who confirmed that many of their patients are reporting skipped periods or have noticed increases or decreases in cycle length, blood volume and level of menstrual-related pain.
"It's common for us to see patients with changes in their menstrual cycle, but anecdotally, it seems like it's been happening more over the last six months," says Beth Schwartz, an OB/GYN at Thomas Jefferson University Hospital in Philadelphia and Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del. "I definitely think covid-19 is playing a role in that."
After all, the pandemic has upended our normal routines and jacked up our anxiety. And stress levels can affect the menstrual cycle, as can changes in work schedules (or job status), sleep patterns, eating habits and exercise routines, which many of us have experienced since March. But how can you tell what's causing variations in your cycle and whether you need to check in with your doctor? I asked the experts for their advice.
It helps to understand how menstruation is regulated. "Most people think the control of the menstrual cycle resides in the uterus, but it doesn't," says Mary Jane Minkin, a gynecologist at the Yale School of Medicine in New Haven, Conn. "It resides in your brain."
Specifically, it resides in the hypothalamus, which manages the pituitary gland and controls the release of different hormones, some of which trigger the ovaries to make estrogen and progesterone.
These two hormones thicken the lining of the uterus to prepare the body for pregnancy. If you don't get pregnant during a cycle, hormone levels drop and the lining of the uterus sheds. This is the bleeding we know as menstruation, or simply, your period.
(Interestingly, some data show that women fare better than men who get Covid-19, the disease caused by the novel coronavirus, and researchers hypothesize that estrogen and progesterone may play a role. Researchers in New York and Los Angeles are treating male covid-19 patients with these hormones to see if they help support immunity, though this is far from definitive.)
The tiny hypothalamus has outsize importance. In addition to your period, it also helps control heart rate, blood pressure and how much we eat, drink and sleep. And it responds to stress. When information received by the hypothalamus changes, the whole body - including the menstrual cycle - can be affected.
"There are a lot of things that can interfere with regular ovulatory control," Minkin says. "It's a really intricate setup, and any stressor can whack the whole thing up." Even something that seems innocuous, such as taking a new vitamin, herbal supplement or medication, can affect your cycle, as can changing the time of day you take your birth control pill.
Being ill with the coronavirus can mess with your cycle, too. "Any significant illness can throw the menstrual system out of rhythm," Minkin says. "I'd be reluctant to say this is particularly related to the covid virus, per se; it's related to being sick in general."
Boston-based dietitian Elizabeth Ward, co-author of "The Menopause Diet Plan," notes that sudden changes in weight can also affect menses. Some women have gained or lost weight because of the stress of the pandemic; both extremes can affect women's hormones and menstrual cycles.
Good nutrition can counteract some of the negative effects of stress, says Ward, who suggests eating an anti-inflammatory, plant-based diet. "It doesn't need to be completely animal-free," she says, "but most of your plate can come from plant-based foods: Fill half your plate with vegetables and fruit, a quarter of your plate with whole grains and a quarter with good sources of protein, such as seafood, eggs and tofu."
Exercise is also a great way to reduce stress, but Ward cautions against overdoing it: "Exchanging one form of stress for another stressor - like way too much exercise - is not a good thing. If your body fat goes too low, you are going to lose your period."
If your period has been early, late or heavier than usual during the pandemic, it's probably nothing to worry about, the gynecologists I spoke with say. Both Schwartz and Minkin say that skipping a period is seldom worrisome, but they advise you to check with your health-care provider if you feel nervous about anything. That peace of mind can help reduce stress.
"Even if it seems like nothing, it's always a good idea to discuss any concerns with your doctor," Schwartz says.
And it might have nothing to do with the pandemic. Although skipping a period may seem like normal fluctuation due to coronavirus stress, don't overlook the possibility that you could be pregnant. "If someone is sexually active, even if they are on birth control, it's always a good idea to take a pregnancy test if your menstrual pattern has changed," Schwartz says.
Of course, if you are trying to get pregnant, an irregular cycle can be frustrating. "If your menstrual cycle is irregular, you can't track ovulation as well, which makes it harder to become pregnant," Minkin says. She suggests speaking with your healthcare provider about ways to regulate ovulation.
If you're not trying to get pregnant, use a reliable form of birth control. Don't count on the rhythm method (tracking your menstrual history to predict when you'll ovulate); if your ovulation is unpredictable, you could get pregnant accidentally. That's probably not the kind of additional stress you need right now.
If you are in your 40s, a missed period could also be due to the onset of perimenopause, which is the normal transition phase before menopause. "Every day in America, about 2 000 women have their last period and are through that menopause transition," Ward says. "However, millions more are going through perimenopause, which can last up to 10 years." During this transition, it's normal for periods to be irregular and heavier or lighter than before.
If your skipped period is coupled with symptoms such as hot flashes, vaginal dryness and trouble sleeping, that certainly can be indicative of perimenopause. Schwartz suggests tracking your cycle and related symptoms in a notebook or period app. This history will also help your doctor determine what's going on.
Although an irregular period usually poses little cause for concern, there are certain situations where you should alert your doctor. "I tell my patients [who are not menopausal] that if they go more than three months without a period at any point, I want to know about it," Schwartz says. "It's not an emergency and they should not freak out that anything is seriously wrong, but it should be evaluated at that point."
Some disorders of the hypothalamus, pituitary gland or ovaries can affect menstruation. Minkin says that patients with persistent irregularities can talk to their doctor about having their thyroid and pituitary hormone levels tested.
The other thing to keep track of is spotting between periods. "Spotting tends to be less about wacky cycles due to stress and may be due to a polyp or something else," Minkin says. "It's no reason to panic at all, but you can certainly ask your health-care provider about it."
When checking in with your health-care provider about a change in your cycle, make sure to discuss sleep, exercise, eating habits, stress, medication and supplements, so your provider gets a full picture of your current lifestyle. For me, it was just a blip in the cycle, and things were back on track the following month.